Provider Demographics
NPI:1447423975
Name:SWEET MEDICINE THERAPY LLC
Entity type:Organization
Organization Name:SWEET MEDICINE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:DEHART
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:406-683-4453
Mailing Address - Street 1:435 S ATLANTIC ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DILLON
Mailing Address - State:MT
Mailing Address - Zip Code:59725-2726
Mailing Address - Country:US
Mailing Address - Phone:406-683-4453
Mailing Address - Fax:406-683-4453
Practice Address - Street 1:435 S ATLANTIC ST
Practice Address - Street 2:SUITE 104
Practice Address - City:DILLON
Practice Address - State:MT
Practice Address - Zip Code:59725-2726
Practice Address - Country:US
Practice Address - Phone:406-683-4453
Practice Address - Fax:406-683-4453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT524261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0340323Medicaid